SUFU 2018: Sacrocolpopexy: Tips and Tricks

Austin, TX (UroToday.com) Sacrocolpopexy background: Apical recurrence with abdominal sacrocolpopexy (ASC)( 9% at 2 years, 22% at 7 years) Cochrane review supports ASC vs. native tissue vaginal repairs.  Balance with increased risk of SE.  Lap and robotic technology is improving (outcome data emerging, promising, SE possible, convalescence improved.
Tips and Tricks:
  • Performed perineorrhaphy 1st (may be as sometimes difficult at the end, sling?).
  • He used Si, with left side docking ( >10 cm apart, 8 mm x 3, 12 mm camera port( preplace suture), 11 mm assistant port)
  • #1  for monopolar scissors, #2 Maryland bipolar forceps, #3 Fenestrated graspers/prograsp.
Steps:
  • Lysis of adhesion.
  • Peritoneal Trough rather than tunnel.
  • Anterior plane dissection: standard
  • Posterior plane.
  • Y shape mesh
  • Anterior mesh suturing with ethibon interrupted sutures ( 3 sutures /2 rows)
  • Suture posterior part
  • Fixed the tail of the mesh into the anterior longitudinal ligament (2-3 stitches)
  • Retropertonealzed the mesh with delayed absorbable suture( v lock) 
Conclusion:
  • Additional vaginal work first? Think
  • Preplace sutures for camera port
  • Comprehensive adhesiolysis
  • Tactile confirmation of promontory
  • Separated assistant for vaginal manipulation
  • Peritoneal cap on apex
  • Bladder muscularis visible

Presented by: Alex Gomelsky, MD, LSU health- Shreveport

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas
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